Explore the vast range of titles available.

Patients with hematological malignancies are at increased risk of severe COVID-19 outcomes due to compromised immune responses, but the insights of these studies have been compromised due to intrinsic limitations in study design. Here we present the PROSECO prospective observational study ( NCT04858568 ) on 457 patients with lymphoma that received two or three COVID-19 vaccine doses. We show undetectable humoral responses following two vaccine doses in 52% of patients undergoing active anticancer treatment. Moreover, 60% of patients on anti-CD20 therapy had undetectable antibodies following full vaccination within 12 months of receiving their anticancer therapy. However, 70% of individuals with indolent B-cell lymphoma displayed improved antibody responses following booster vaccination. Notably, 63% of all patients displayed antigen-specific T-cell responses, which increased after a third dose irrespective of their cancer treatment status. Our results emphasize the urgency of careful monitoring of COVID-19-specific immune responses to guide vaccination schemes in these vulnerable populations.

Haemophagocytic lymphohistiocytosis (HLH) is a severe systemic inflammatory syndrome. Over activation of histiocytes and lymphocytes can lead to multiorgan failure and death. The three key features are fever, raised ferritin and falling counts, that is, cytopenia (3Fs). Treatment is immunosuppression while identifying the driver. Our young female patient presented with high fever and extensive lymphadenopathy, raising the suspicion of HLH driven by lymphoma. Her H-score was consistent with HLH. Immunosuppression was commenced with intravenous steroids, followed by anakinra due to inadequate steroid response. She required intensive care unit (ICU) admission with input from haematology and rheumatology. A lymph node biopsy revealed likely Kikuchi-Fujimoto disease, a rare benign cause of painful lymphadenopathy that is usually self-limiting but is also reported as a cause of HLH. She responded rapidly to anakinra and was discharged home 1 week after leaving ICU. Regular clinic follow-up continues, immunosuppression has been weaned off and she remains in remission. Monitoring for later development of autoimmune disease continues. We discuss her management with reference to the recently published Getting it Right First Time guidelines on HLH.